FEDERAL EMERGENCY MANAGEMENT AGENCY
CONTRACT WORK SUMMARY RECORD	Page	     	of	     		
		
1.	APPLICANT
     	2.	PA ID
     	3.	PW #
     	4.	DISASTER NUMBER
     	
5.	LOCATION/SITE
     	6.	CATEGORY
	7.	PERIOD COVERING
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8.	DESCRIPTION OF WORK PERFORMED
     	
DATES WORKED	CONTRACTOR	BILLING/INVOICE NUMBER	AMOUNT	COMMENTS—SCOPE	
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GRAND TOTAL	$	     		
I CERTIFY THAT THE ABOVE INFORMATION WAS OBTAINED FROM PAYROLL RECORDS, INVOICES, OR OTHER DOCUMENTS THAT ARE AVAILABLE FOR AUDIT.	
CERTIFIED
     	TITLE
     	DATE
     	
FEMA Form 90-126, NOV 98